Ophthalmology, October 2017
Elam et al. compared the receipt of glaucoma care between patients with Medicaid and those with commercial health insurance. They found that, regardless of race or ethnicity, patients with commercial plans received substantially more monitoring.
For this longitudinal study, records were reviewed for 18,372 commercial plan (managed care) members and 3,394 Medicaid members with newly diagnosed open-angle glaucoma (OAG). The proportion of patients who received the following exams within 15 months of diagnosis was documented: visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI). Odds ratios (OR) were calculated, and multivariable logistic regression was applied to determine the extent to which race/ethnicity and type of health insurance affected the odds of having a glaucoma monitoring test.
The proportions of patients with commercial plans who underwent VF testing, FP, and OOI were 63%, 22%, and 54%, respectively. In comparison, those percentages for Medicaid members were 35%, 19%, and 30%. Patients with Medicaid were 234% more likely to not receive any glaucoma-related test within 15 months of diagnosis.
With regard to race and ethnicity, after adjusting for confounders, the odds of white Medicaid members having no glaucoma test were found to be 198% greater than for whites with commercial health insurance. Black Medicaid members were even less likely to be tested; the odds of no testing were 291% higher among those with Medicaid.
The findings emphasize the profound impact of race and type of health plan on the care of patients with OAG, the authors said, and they concluded that considerable efforts are needed to improve the quality and timeliness of glaucoma care for Medicaid recipients, especially those who are black and/or are members of other minority groups. (See related commentary by Eve J. Higginbotham, SM, MD, in the same issue.)
The original article can be found here.